Thanks for highlighting this,
@duncan. I have concerns too. I have sent emails to both KevinMD.com and the American College of Physicians (publisher of MKSAP 17 from which the case study was reportedly excerpted). I focused on diagnosis only, picking my battles, as the saying goes.
Could someone post the diagnostic algorithm for SEID on this thread? And then tell me how to do it? It's on p.10 of the clinician's guide to the IOM report here
https://www.nap.edu/resource/19012/MECFScliniciansguide.pdf (p.10 according to the numbering on the document, p.14 on Adobe Reader).
Dear Kevin MD,
I recently came across a diagnostic challenge on your website, for a 36 year old man with a history of fatigue:
http://www.kevinmd.com/blog/2017/08/mksap-36-year-old-man-history-fatigue.html
Since the diagnostic label used here is SEID, this patient should fulfil SEID diagnostic criteria, which were described in the 2015 IOM report. The patient described does not fulfil SEID diagnostic criteria.
The history provided does not mention substantial decrease in function (required for diagnosis of SEID), post-exertional malaise (required for diagnosis of SEID), cognitive dysfunction or orthostatic intolerance (one or both are required for diagnosis of SEID), so the patient should not be diagnosed with SEID or ME/CFS.
The clinician’s guide to the 2015 IOM report with SEID diagnostic algorithm can be downloaded for free here:
https://www.nap.edu/resource/19012/MECFScliniciansguide.pdf, with more detailed information available here:
https://www.nap.edu/catalog/19012/b...hronic-fatigue-syndrome-redefining-an-illness.
Putting testing and treatment aside, the physician in this case needs to go back and do a proper case history to ensure accurate diagnosis.
I understand that this case was excerpted from MKSAP 17. Unfortunately by reproducing it, more physicians will be misled as to how to accurately diagnose SEID/ME/CFS.
I hope you will consider removing it from your website, and replacing it with a case history that does fulfil SEID diagnostic criteria. Publication of the SEID diagnostic algorithm from p.10 of the clinician's guide (link above) would also be helpful.
Please advise how you are going to rectify this situation.
Kind regards,
To ACP:
Dear Sir or Madam,
I recently came across what was described as an excerpt from the MSKAP 17, namely a diagnostic challenge for a 36 year old man with a history of fatigue:
http://www.kevinmd.com/blog/2017/08/mksap-36-year-old-man-history-fatigue.html
Since the diagnostic label used here is SEID, this patient should fulfil SEID diagnostic criteria, which were described in the 2015 IOM report. The patient described does not fulfil SEID diagnostic criteria.
The history provided does not mention substantial decrease in function (required for diagnosis of SEID), post-exertional malaise (required for diagnosis of SEID), cognitive dysfunction or orthostatic intolerance (one or both are required for diagnosis of SEID), so the patient should not be diagnosed with SEID or ME/CFS.
The clinician’s guide to the 2015 IOM report with SEID diagnostic algorithm can be downloaded for free here:
https://www.nap.edu/resource/19012/MECFScliniciansguide.pdf, with more detailed information available here:
https://www.nap.edu/catalog/19012/b...hronic-fatigue-syndrome-redefining-an-illness.
Putting testing and treatment aside, the physician in this case needs to go back and do a proper case history to ensure accurate diagnosis.
This case history/diagnostic challenge will mislead physicians as to how to accurately diagnose SEID/ME/CFS. I hope you will consider removing it from your website, and replacing it with a case history that does fulfil SEID diagnostic criteria.
One solution would be to ask one of the SEID/ME/CFS physician experts involved in the drafting of the IOM report and diagnostic criteria to submit a case history that does fulfil SEID diagnostic criteria, for example, Nancy Klimas (Nova Southeastern University, Miami), Ronald Davis (Stanford), Peter Rowe (Johns Hopkins) or Lucinda Bateman (Salt Lake City).
Please advise how you are going to rectify this situation.
Kind regards,